Provider Demographics
NPI:1255366985
Name:CAROLINA MEDICAL SPAS PA
Entity type:Organization
Organization Name:CAROLINA MEDICAL SPAS PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GISELE
Authorized Official - Middle Name:J
Authorized Official - Last Name:GIRAULT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:980-297-7873
Mailing Address - Street 1:8035 PROVIDENCE RD
Mailing Address - Street 2:STE 340
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28277-9716
Mailing Address - Country:US
Mailing Address - Phone:980-297-7873
Mailing Address - Fax:980-297-7874
Practice Address - Street 1:145 LAKE POINT DR
Practice Address - Street 2:
Practice Address - City:FORT MILL
Practice Address - State:SC
Practice Address - Zip Code:29708-7870
Practice Address - Country:US
Practice Address - Phone:803-389-5961
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCF97660Medicare UPIN